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Catatonia in adults: Epidemiology, clinical features, assessment, and diagnosis

M Justin Coffey, MD
Section Editors
Peter P Roy-Byrne, MD
Stephen Marder, MD
Deputy Editor
David Solomon, MD


Catatonia is a behavioral syndrome marked by an inability to move normally, which can occur in the context of many underlying psychiatric and general medical disorders [1]. Within psychiatric nosology, catatonia is not conceptualized as a separate diagnostic entity [2,3]. Rather, the term catatonia is used to specify a subtype of the underlying disorder, similar to the term “psychotic features.” (However, some experts view catatonia as a syndrome that warrants a stand-alone diagnosis [4].)

Recognizing catatonia is important because it may be caused or exacerbated by treatment of the underlying disorder. As an example, antipsychotic drugs used for bipolar or psychotic disorders may worsen catatonia [5].

This topic reviews the epidemiology, pathogenesis, clinical features, assessment, and diagnosis of catatonia, as well as the disorders that can progress to catatonia. The treatment and prognosis of catatonia are discussed separately. (See "Catatonia: Treatment and prognosis".)


The estimated incidence of catatonia has been studied primarily in acutely ill psychiatric inpatients [2]. The incidence is approximately 10 percent, but estimates range from 5 to 20 percent, based upon prospective studies conducted for one to twelve months at individual psychiatric units [6-14]. The range is probably due in part to differences in study methods, including how catatonia was defined. The syndrome may go unrecognized, leading to the false conclusion that it is rare. In a Dutch study of 139 acutely psychotic inpatients, the treatment team diagnosed catatonia nine times less often than the research team (2 versus 18 percent of patients) [8].

It is not clear if there are any sociodemographic risk factors for catatonia. Catatonia seems to occur more commonly in patients with unipolar major depression or bipolar disorder, compared with other disorders [6]. In addition, catatonia may perhaps occur more often in patients with prior episodes. (See 'Underlying disorders' below and 'Recurrence' below.)

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Literature review current through: Nov 2017. | This topic last updated: Nov 22, 2017.
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  1. Fink M, Taylor MA. The catatonia syndrome: forgotten but not gone. Arch Gen Psychiatry 2009; 66:1173.
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.
  3. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines. World Health Organization. http://www.who.int/classifications/icd/en/bluebook.pdf (Accessed on October 29, 2013).
  4. Fink M. Catatonia from its creation to DSM-V: Considerations for ICD. Indian J Psychiatry 2011; 53:214.
  5. Lee JW. Neuroleptic-induced catatonia: clinical presentation, response to benzodiazepines, and relationship to neuroleptic malignant syndrome. J Clin Psychopharmacol 2010; 30:3.
  6. Taylor MA, Fink M. Catatonia in psychiatric classification: a home of its own. Am J Psychiatry 2003; 160:1233.
  7. Francis A, Fink M, Appiani F, et al. Catatonia in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. J ECT 2010; 26:246.
  8. van der Heijden FM, Tuinier S, Arts NJ, et al. Catatonia: disappeared or under-diagnosed? Psychopathology 2005; 38:3.
  9. Freudenreich O, Nejad SH, Francis A, Fricchione GL. Psychosis, mania, and catatonia. In: Textbook of Psychosomatic Medicine: Psychiatric Care of the Medically Ill, Second Edition, Levenson JL (Ed), American Psychiatric Publishing, Washington, DC 2011. p.219.
  10. Chalasani P, Healy D, Morriss R. Presentation and frequency of catatonia in new admissions to two acute psychiatric admission units in India and Wales. Psychol Med 2005; 35:1667.
  11. Zisselman MH, Jaffe RL. ECT in the treatment of a patient with catatonia: consent and complications. Am J Psychiatry 2010; 167:127.
  12. Rosebush PI, Hildebrand AM, Furlong BG, Mazurek MF. Catatonic syndrome in a general psychiatric inpatient population: frequency, clinical presentation, and response to lorazepam. J Clin Psychiatry 1990; 51:357.
  13. Ungvari GS, Leung CM, Wong MK, Lau J. Benzodiazepines in the treatment of catatonic syndrome. Acta Psychiatr Scand 1994; 89:285.
  14. Seethalakshmi R, Dhavale S, Suggu K, Dewan M. Catatonic syndrome: importance of detection and treatment with lorazepam. Ann Clin Psychiatry 2008; 20:5.
  15. Dhossche DM, Stoppelbein L, Rout UK. Etiopathogenesis of catatonia: generalizations and working hypotheses. J ECT 2010; 26:253.
  16. Mann SC, Caroff SN, Campbell EC, et al. Malignant catatonia. In: Current Clinical Neurology: Movement Disorder Emergencies: Diagnosis and Treatment, Frucht SI, Fahn S (Eds), Humana Press, Totowa, NJ 2005. p.53.
  17. Northoff G. What catatonia can tell us about "top-down modulation": a neuropsychiatric hypothesis. Behav Brain Sci 2002; 25:555.
  18. Northoff G. Catatonia and neuroleptic malignant syndrome: psychopathology and pathophysiology. J Neural Transm (Vienna) 2002; 109:1453.
  19. Northoff G. Brain imaging in catatonia: current findings and a pathophysiologic model. CNS Spectr 2000; 5:34.
  20. Northoff G, Steinke R, Nagel DCzerwenka C, et al. Right lower prefronto-parietal cortical dysfunction in akinetic catatonia: a combined study of neuropsychology and regional cerebral blood flow. Psychol Med 2000; 30:583.
  21. Carroll BT. The universal field hypothesis of catatonia and neuroleptic malignant syndrome. CNS Spectr 2000; 5:26.
  22. Meyer J, Huberth A, Ortega G, et al. A missense mutation in a novel gene encoding a putative cation channel is associated with catatonic schizophrenia in a large pedigree. Mol Psychiatry 2001; 6:302.
  23. Stöber G. Genetic predisposition and environmental causes in periodic and systematic catatonia. Eur Arch Psychiatry Clin Neurosci 2001; 251 Suppl 1:I21.
  24. Stöber G, Pfuhlmann B, Nürnberg G, et al. Towards the genetic basis of periodic catatonia: pedigree sample for genome scan I and II. Eur Arch Psychiatry Clin Neurosci 2001; 251 Suppl 1:I25.
  25. Stöber G, Seelow D, Rüschendorf F, et al. Periodic catatonia: confirmation of linkage to chromosome 15 and further evidence for genetic heterogeneity. Hum Genet 2002; 111:323.
  26. Francis A. Catatonia: diagnosis, classification, and treatment. Curr Psychiatry Rep 2010; 12:180.
  27. Lewis S, Escalona PR, Keith SJ. Phenomenology of schizophrenia. In: Kaplan & Sadock's Comprehensive Textbook of Psychiatry, Ninth Edition, Sadock BJ, Sadock VA, Ruiz P (Eds), Lippincott Williams & Wilkins, Philadelphia 2009. Vol I, p.1433.
  28. Fink M, Taylor MA. Catatonia: subtype or syndrome in DSM? Am J Psychiatry 2006; 163:1875.
  29. Fink M, Taylor MA. The many varieties of catatonia. Eur Arch Psychiatry Clin Neurosci 2001; 251 Suppl 1:I8.
  30. Bush G, Fink M, Petrides G, et al. Catatonia. II. Treatment with lorazepam and electroconvulsive therapy. Acta Psychiatr Scand 1996; 93:137.
  31. Peralta V, Cuesta MJ, Serrano JF, Martinez-Larrea JA. Classification issues in catatonia. Eur Arch Psychiatry Clin Neurosci 2001; 251 Suppl 1:I14.
  32. Daniels J. Catatonia: clinical aspects and neurobiological correlates. J Neuropsychiatry Clin Neurosci 2009; 21:371.
  33. Penland HR, Weder N, Tampi RR. The catatonic dilemma expanded. Ann Gen Psychiatry 2006; 5:14.
  34. Fink M. Catatonia: a syndrome appears, disappears, and is rediscovered. Can J Psychiatry 2009; 54:437.
  35. Trigo M, Crippa J, Hallak J, et al. The complexity of the differential diagnosis in psychiatry exemplified by a catatonic syndrome. Rev Psiquiatr Clin 2001; 28:144.
  36. Northoff G, Wenke J, Pflug B. Increase of serum creatine phosphokinase in catatonia: an investigation in 32 acute catatonic patients. Psychol Med 1996; 26:547.
  37. Cottencin O, Warembourg F, de Chouly de Lenclave MB, et al. Catatonia and consultation-liaison psychiatry study of 12 cases. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31:1170.
  38. Carroll BT, Anfinson TJ, Kennedy JC, et al. Catatonic disorder due to general medical conditions. J Neuropsychiatry Clin Neurosci 1994; 6:122.
  39. Taylor MA, Abrams R. Catatonia. Prevalence and importance in the manic phase of manic-depressive illness. Arch Gen Psychiatry 1977; 34:1223.
  40. Takaoka K, Takata T. Catatonia in high-functioning autism spectrum disorders: case report and review of literature. Psychol Rep 2007; 101:961.
  41. Wing L, Shah A. A systematic examination of catatonia-like clinical pictures in autism spectrum disorders. Int Rev Neurobiol 2006; 72:21.
  42. Oldham MA, Hochang BL. Catatonia vis-a-vis delirium: The significance of recognizing catatonia in altered mental status. Gen Hosp Psychiatry 2015.
  43. Grover S, Parakh P, Sharma A, et al. Catatonia in systemic lupus erythematosus: a case report and review of literature. Lupus 2013; 22:634.
  44. Smith JH, Smith VD, Philbrick KL, Kumar N. Catatonic disorder due to a general medical or psychiatric condition. J Neuropsychiatry Clin Neurosci 2012; 24:198.
  45. Wilson JE, Carlson R, Duggan MC, et al. Delirium and Catatonia in Critically Ill Patients: The Delirium and Catatonia Prospective Cohort Investigation. Crit Care Med 2017; 45:1837.
  46. Rosebush PI, Mazurek MF. Catatonia and its treatment. Schizophr Bull 2010; 36:239.
  47. Ungvari GS, Caroff SN, Gerevich J. The catatonia conundrum: evidence of psychomotor phenomena as a symptom dimension in psychotic disorders. Schizophr Bull 2010; 36:231.
  48. Medda P, Toni C, Luchini F, et al. Catatonia in 26 patients with bipolar disorder: clinical features and response to electroconvulsive therapy. Bipolar Disord 2015; 17:892.
  49. Sienaert P, Rooseleer J, De Fruyt J. Measuring catatonia: a systematic review of rating scales. J Affect Disord 2011; 135:1.
  50. Bush G, Fink M, Petrides G, et al. Catatonia. I. Rating scale and standardized examination. Acta Psychiatr Scand 1996; 93:129.
  51. Northoff G, Koch A, Wenke J, et al. Catatonia as a psychomotor syndrome: a rating scale and extrapyramidal motor symptoms. Mov Disord 1999; 14:404.
  52. Carroll BT, Kirkhart R, Ahuja N, et al. Katatonia: a new conceptual understanding of catatonia and a new rating scale. Psychiatry (Edgmont) 2008; 5:42.
  53. Lee JW. Serum iron in catatonia and neuroleptic malignant syndrome. Biol Psychiatry 1998; 44:499.
  54. Carroll BT, Goforth HW. Serum iron in catatonia. Biol Psychiatry 1995; 38:776.
  55. Singerman B, Raheja R. Malignant catatonia--a continuing reality. Ann Clin Psychiatry 1994; 6:259.
  56. Koek RJ, Mervis JR. Treatment-refractory catatonia, ECT, and parenteral lorazepam. Am J Psychiatry 1999; 156:160.
  57. Schmider J, Standhart H, Deuschle M, et al. A double-blind comparison of lorazepam and oxazepam in psychomotor retardation and mutism. Biol Psychiatry 1999; 46:437.
  58. Zaw ZF, Bates GD. Replication of zolpidem test for catatonia in an adolescent. Lancet 1997; 349:1914.
  59. Thomas P, Rascle C, Mastain B, et al. Test for catatonia with zolpidem. Lancet 1997; 349:702.
  60. Cottencin O, Danel T, Goudemand M, et al. Catatonia recognition and treatment. Med Sci Monit 2009; 15:CS129.
  61. Strawn JR, Keck PE Jr, Caroff SN. Neuroleptic malignant syndrome. Am J Psychiatry 2007; 164:870.
  62. Fricchione GL. Neuroleptic catatonia and its relationship to psychogenic catatonia. Biol Psychiatry 1985; 20:304.
  63. Caroff SN, Mann SC, Keck PE Jr. Specific treatment of the neuroleptic malignant syndrome. Biol Psychiatry 1998; 44:378.
  64. Fink M, Taylor MA. Neuroleptic malignant syndrome is malignant catatonia, warranting treatments efficacious for catatonia. Prog Neuropsychopharmacol Biol Psychiatry 2006; 30:1182.
  65. Castillo E, Rubin RT, Holsboer-Trachsler E. Clinical differentiation between lethal catatonia and neuroleptic malignant syndrome. Am J Psychiatry 1989; 146:324.
  66. Fleischhacker WW, Unterweger B, Kane JM, Hinterhuber H. The neuroleptic malignant syndrome and its differentiation from lethal catatonia. Acta Psychiatr Scand 1990; 81:3.
  67. Keck PE, Arnold LM. The serotonin syndrome. Psychiatr Ann 2000; 30:333.
  68. Sarkis RA, Coffey MJ, Cooper JJ, et al. Anti-N-methyl-D-aspartate receptor encephalitis: a review of psychiatric phenotypes and management considerations. A report of the American Neuropsychiatric Association Committee on Research. J Neuropsychiatry Clin Neurosci 2017.